Context: Recently, 22 people had died after consuming spurious liquor in the Chengalpattu and Villupuram districts of Tamil Nadu. The article explains the harmful impact of alcohol and measures needed to treat those.

• This event has come as a surprise as the liquor sales in Tamil Nadu are wholly controlled by the State.

What is the alcohol in liquor?

• Liquor is differentiated by its alcohol content. For example, beer contains 5% of alcohol content by volume, wine contains about 12% and other distilled spirits contain about 40%.

• Usually, the alcohol used in those beverages consumed for recreational purposes is ethanol (ethyl alcohol).

• Ethanol (C2H5OH) molecule is one carbon atom bonded to three hydrogen atoms and one more carbon atom. The second carbon atom is bonded to two hydrogen atoms and the hydroxyl group known as the ion “OH–”. 

• Ethanol is a psychoactive drug that causes intoxicating effects by reducing the level of neurotransmission in the body.

• Ethanol is metabolised inside the human body by the liver and the stomach by alcohol dehydrogenase (ADH) enzymes into acetaldehyde. 

• Later the aldehyde dehydrogenase (ALDH) enzymes convert the acetaldehyde into acetate. 

• According to the World Health Organization (WHO), “no level of its consumption is safe for human health”. 

• Long-term addiction to alcohol might result in dependence, and increased risk of some cancers and heart diseases.

• The adverse health effects such as hangovers and a few types of cancers, are mainly due to acetaldehyde.

Spurious liquor

• Spurious liquors are those which contain methanol (methyl alcohol) which is also known as wood alcohol.

• The arrack (Spurious liquor) sellers usually purchase industrial-grade methanol from factories and utilise it to make low-grade, country-made liquor.

• In such cases, methanol is usually added to strengthen the intoxicating effects and/or to increase the volume of the liquor made.

Methanol

• Methanol (CH3OH) molecule consists of one carbon atom bonded with three hydrogen atoms and one hydroxyl group.

• Methanol has numerous industrial applications.

• It is used as a precursor to acetic acid, formaldehyde, and aromatic hydrocarbons. 

• It is also used as a solvent and as an antifreeze.

• Methanol is commonly produced by combining carbon monoxide and hydrogen in the presence of copper and zinc oxides as catalysts at 50-100 atm of pressure and 250°C. 

• During the pre-industrial era, in ancient Egypt, people used to produce methanol by heating wood to a very high temperature.

Ill effects of the consumption of spurious liquor

• Methanol is the main reason for the deadliness of spurious liquor.

• The human body usually contains minute quantities of methanol because of the consumption of certain fruits. However, even more than 0.1 ml of pure methanol per kilogram of body weight can have serious health implications for humans.

• When consumed, methanol is metabolised in the liver by ADH enzymes into formaldehyde (H-CHO). 

• Later, the ALDH enzymes transform formaldehyde into formic acid (HCOOH). 

• The accumulation of formic acid causes metabolic acidosis which can further lead to acidemia, a condition wherein the blood’s pH drops below its normal value of 7.35, becoming increasingly acidic.

• Formic acid can also affect the functioning of the enzyme called cytochrome oxidase, which affects the ability of the cells to use oxygen and results in the build-up of lactic acid, contributing to acidosis.

• According to various reports, methanol consumption also causes “methanol-induced optic neuropathy”.

• This condition may further lead to long-term or irreversible visual impairment or even blindness.

• Ophthalmic effects have been seen in more than 50% of those individuals who have consumed methanol.

• Methanol poisoning can also cause cerebral oedema, haemorrhage, and death.

• However, if a person has consumed ethanol along with the methanol, the health implication may not be evident until after a few days thereby delaying treatment and increasing the chance of mortality.

Available treatment

• As methanol is ingested, the human body requires some time to completely eliminate it. 

• As per certain estimates about 33% of methanol still remains in the body even after 48 hours. 

• Methanol is completely absorbed through the gastrointestinal tract and the blood-methanol level can reach its maximum value within just 90 minutes. 

There are two immediate treatment procedures to address methanol poisoning, which include:

• Administering ethanol which competes with methanol for the ADH enzymes. Administering ethanol ensures that methanol is not metabolised into formaldehyde.

• Administering an antidote named “fomepizole”. This antidote slows down the action of the ADH enzymes to produce formaldehyde at a slower rate such that the body can excrete it.

• Fomepizole is expensive compared to pharmaceutical-grade ethanol. However, administering ethanol requires the supervision of healthcare workers.

• Individuals might also have to undergo a dialysis procedure to remove methanol and formic acid salts from the blood in order to reduce kidney and retina damage. 

• Folinic acid might also be administered to break up the formic acid into carbon dioxide and water. 

• Fomepizole as well as folinic acid are listed under the WHO’s list of essential medicines.

• The formic acid would have begun accumulating in dangerous amounts around 18-24 hours after ingestion, affecting the optic nerve, kidneys, heart, and brain. 

Efforts undertaken by the government

• The Food Safety and Standards (Alcoholic Beverages) Regulations, 2018, mentions the maximum permissible amount of methanol in various liquors.

• For example, methanol must be “absent” in coconut fenny, 50 grams per 100 litres in country liquor, and 300 grams per 100 litres in pot-distilled spirits.

• Methanol is also included under Schedule I of the Manufacture, Storage and Import of Hazardous Chemical Rules, 1989. 

• The Indian Standard IS 517 mentions ways to determine the quality of methanol.

• The Indian Standards along with the Tamil Nadu Denatured Spirit, Methyl Alcohol, and Varnish (French Polish) Rules, 1959, mentions the signage that a methanol packaging should carry. 

• The manufacturing, export, import, storage, and sale of methanol in Tamil Nadu requires licences under the 1959 Rules.

• Taking suo motu cognisance of reports of people dying after consuming spurious liquor in Villupuram and Chengalpattu districts, the National Human Rights Commission (NHRC) has issued notices to the Tamil Nadu Chief Secretary and the Director-General of Police, seeking a detailed response from them within four weeks.